Phone numbers and websites of all carriers is available by scrolling all the way to the bottom of this page.  A printable list is available by clicking here.

welcome new employees!!

For those of you eligible for health and welfare benefits, please review this brief summary of all the benefit plans (including optional benefits) available to you.  Enrollment forms for our medical plans (chose one), dental, and vision plans are also included.  Details on each plan can be found by scrolling down this page and will be discussed during your New Employee Orientation.

Brief Summary of All Health & Welfare Benefits

BENEFIT PLANS for active employees

Medical Plans

Anthem Blue Cross (Enrollment Packet for ALL benefit eligible Active employees)

Active Employee's Plan Summary including Prescription Coverage (Anthem Blue Cross)

Active Employee's Enrollment Guidebook (Anthem Blue Cross)

Costco Mail Order Prescription Form (Anthem Blue Cross Enrollees Only)

Anthem Mobile App Instructions

Anthem Hip, Knee & Spine Surgeries (Blue Distinction REQUIREMENTS)

SISC III Enrollment Form (Anthem Blue Cross)

SISC III Membership Change Form (to add/terminate dependents, update address/name)

Anthem In-Network Labs (SISC)

How to Print a Temporary ID Card (Anthem Blue Cross only)

 

Kaiser Permanente (Enrollment Packet for ALL benefit eligible employees including Adjunct Faculty) 

Active Employee's Plan Summary (Kaiser)

Kaiser Active Plan Summary (Spanish)

Active Employee's Enrollment Guidebook (Kaiser)

Chiropractic & Acupuncture Benefits (NEW)

Dental Plan

Beginning October 1st, the $2,500 annual cap for services is lifted.  As long as you continue to treat with a Delta PPO provider, you will have no annual cap (so if you are unlucky enough to need three crowns in one year, you may not have any out of pocket expenses).  Also, if you or a covered dependent needs braces, orthodontia is now covered at 100% up to a lifetime maximum of $3,000.  Bridges and dentures however are now only covered at 50% (was 70%).  Below is a plan summary as well as a comparison chart comparing our old plan with our new plan.  

Delta Dental Plan Summary (eff 10/01/2018)

Old Delta Dental Plan vs. New Plan Comparison Chart

Vision Plan 

Beginning October 1st, the frame allowance is increasing, examinations are available every 12 months, and the allowance for contact lenses is increasing. 

VSP Plan Summary (effective 10/01/2018)

Old VSP Plan vs. New VSP Plan Comparison Chart

VSP TruHearing Hearing Aid Discount Program

Employee Assistance Plan (EAP)

AnthemEAP plans offer confidential counseling services to all our benefit eligible employees and covered retirees, their dependents and anyone living in the employee/covered retiree's household.  Telephonic, electronic (like Facetime or Skype), and in person counseling services are available, as are legal services, financial planning services, child care assistance, elder care assistance, discounted tickets for movies and attractions, etc., as are resources for tobacco, alcohol and drug dependency and our over all emotional health and mental wellness. 

AnthemEAP Pamphlet

Old EAP (MHN) vs New EAP (Anthem) Comparison Chart

Legal & Financial Services

Child Care Resources

Elder Care Resources

myStrength Emotional Health & Wellness

EAP Savings Center (discount tickets)

Depression Resources

Substance Abuse Resources

Documents Accepted to Prove Dependent Eligibility for all plans (eff 7/1/2018) 

Dependent Eligibility Chart

benefit plans for eligible retirees

Anthem Blue Cross -  

Retiree Plan Summary (For all Covered Retirees eff 7/1/2018)

EAP Plan (See EAP section above for more information on benefits/services available)

 

Kaiser Permanente -

Early Retiree Plan Summary (<65)

EAP Plan (information for those <65)

Senior Advantage Plan Summary (Retirees 65+)

Kaiser Senior Advantage Enrollment Form (for All Kaiser Enrollees >65)

Silver & Fit Flyer For Kaiser Senior Advantage Enrollees Only

AnthemEAP for Kaiser Senior Advantage Enrollees Only

Address, Name, and Dependent Changes:

To change your address, name, add/remove a dependent please print, complete, sign and return the form below to HR.Benefits@sjeccd.edu, fax to 408.239.8804, or mail it via the Pony or US Mail to

Michelle McKay, Human Resources, 40 South Market Street San Jose, CA  95113.

SISC III Member Change Form

Adding Dependents:

Adding an eligible dependent that is not currently covered under your medical, dental and/or vision plan requires a completed original enrollment form and:

• To add a spouse: a copy of your previous year's Federal Tax Return (first page, redacted financial info)
• To add a domestic partner: a copy of your State Registration form (applies to same sex couples only unless one is 62 or older);
• To add your child (adopted, biological, or step): a copy of his/her certified birth certificate and:
• For all plans: SISC III Member Change Form

YOU MUST ENROLL YOUR NEW DEPENDENT(S) WITHIN 30 DAYS OF THE EVENT (birth, marriage, adoption, etc.) or you may not be able to enroll them until the next regular Open Enrollment Period.  ​

Removing Dependents:

As a reminder, it is the employee’s responsibility to notify the Benefits Coordinator in Human Resources within 60 days of the event if you have a covered dependent that ceases to be your dependent; for example:

• You get divorced. 
• Your child between the ages of 19 – 25, gets married or is not a full time student at an accredited institution. (They can remain on Blue Cross or Kaiser, but not dental, vision, the EAP or life insurance). It is your responsibility to notify Human Resources timely.
• Your child becomes an active member of the military.

Failure to timely notify the District (by emailing the Benefits Coordinator in Human Resources) will result in loss of continuation coverage rights under COBRA and may include the carrier(s) billing you for services the ineligible dependent received and/or reimbursement of District paid premiums.

For specific eligibility questions contact the HR Benefits Office at extension 6713 or HR.Benefits@sjeccd.edu.

Waiving Coverage (for employees or dependents)

Health Insurance Portability & Accountability Act (HIPAA): For those who have declined enrollment for themselves, or any employee who elected to not enroll an eligible dependent (spouse, child, domestic partner) because of enrollment in another health insurance plan, you may be able to enroll yourself and your dependents in a District plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents' other coverage) IF you request enrollment within 30 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage).  Failure to notify the Benefits Coordinator timely means you will have to wait until the next regular open enrollment period.

In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents.  However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. 

To request special enrollment or obtain more information, contact Michelle McKay, Benefits Coordinator at 408.223.6713 or HR.Benefits@sjeccd.edu. 

Employees are no longer allowed to waive medical coverage for themselves (with the exception of those currently grandfathered in).  All employees must at least enroll themselves in Kaiser or Anthem Blue Cross.

life Insurance coverage for adult children

Beginning on their 21st birthday and each birth month after that until they turn 23, adult children must be a full-time student at an accredited institution to remain covered by the District's life insurance policy.  Before the last day of their birth month, a copy of their current class schedule indicating their total units, or a letter from the school stating their full-time status, and the form below must be submitted to the Human Resources Department or their life insurance coverage will end.   

Student Certification Form 

Disabled Children

If you have an adult child who is disabled, temporarily or permanently, please contact the Benefits staff in Human Resources at extension 6713 to discuss available options of keeping him/her covered UNDER ALL PLANS regardless of age and/or student status.  Adult children who become disabled after age 26 and become dependent on you may be eligible for enrollment under the District's health and welfare plans.  Please contact HR.Benefits@sjeccd.edu or call 408.223.6713 immediately for more information and required documentation.   

Keep your beneficiaries up to date

• Update your beneficiary(s) for your District paid and/or supplemental life insurance (contact HR.Benefits@sjeccd.edu for supplemental coverage);
• Update your PERS or STRS beneficiary;
• Update your legal name (if you have legally changed it with Social Security)
• Update your home address or telephone number (if you have moved or changed your number recently)
• Update your Emergency Contact information
• Pre-Designate your personal physician to treat you for work related injuries/illnesses 

Please note: due to the number of District employees, we are unable to verify the current emergency contact and/or the beneficiary(s) you have on file. If any time during the year you are unsure of who/what you listed, complete a new form(s) and submit the original(s) to Human Resources. All forms above are available all year long on this page and the Human Resources page. ​​

Flexible Spending Accounts:

Medical Care Reimbursement Account 

• The Medical Care Account Maximum has increased to $2,700.00 (the annual minimum is $240.00).
• You will automatically rollover of up to $500 of unused 2018 contributions to be available for you to use in 2019 (even if you do not open an account for 2019).

Medical Care Reimbursement Account Flyer

Dependent Care Reimbursement Account

• The annual maximum for 2019 remains at $5,000.00

This plan allows you to accumulate pre-tax dollars to reimburse yourself for childcare expenses, and/or day care expenses for a disabled dependent while you are employed. Among the eligible expenses are after-school care or extended day programs, babysitters, elder care expenses (if elder is your dependent), preschool and summer day camp.

Dependent Care Reimbursement Account Flyer

Transportation Account

•  The maximum MONTHLY election allowed is $265.00

This plan allows you to set pre-taxed dollars aside reimbursement of certain transportation expenses incurred as a direct result of your employment.  If you take public transportation (CalTrain, Bart, VTA, etc.). 

Transportation Account Flyer

For more information about Flexible Spending Accounts including forms for additional cards, automatic deposit, and the Orthodontia Treatment Statement are available by scrolling down on this page to the Flexible Spending Account section.

IT IS THE PARTICIPANT'S RESPONSIBILITY TO ASSURE THE EXPENSES THEY USE THE PLAN FOR ARE ELIGIBLE EXPENSES AS EACH PLAN HAS STRICT LIMITATIONS ON WHEN ONE CAN CANCEL THE PLAN MID-YEAR. 

Medical Care Reimbursement Account Carry Over FAQ

iGOE Orthodontia Treatment Statement

Form for Additional Card (for spouse)

iGOE Direct Deposit Form

Dependent Day Care Provider Acknowledgement

Setting up your Website and iGOE App Account

FSA Carryover Employee Fact Sheet

Optional Forms (see below):

• iGOE Direct Deposit Form
• Form for Additional Flex Benefits Card (for spouse)
• Medical Care Worksheet
• Dependent Care Worksheet
• Orthodontia Treatment Statement - Required if the Medical Care Reimbursement Account will be used for orthodontia services for you and/or a dependent

 retirement accounts (403B & 457 plans)

Please refer to Payroll's Public Folder in Outlook for the required forms to enroll in or make changes to a 457 Deferred Compensation Account and for inquires to 403b accounts.

All permanent employees, full and part-time, and adjunct faculty are eligible to enroll in either plan. It does not matter whether you are currently a member of PERS or STRS. It also does not matter what union or constituency group to which you belong.

Plans available to you through your employment with the District (if eligible) are with one of the carriers below:

• CalPERS 457 Plan
• TIAA CREF
• Valic  

ALL ENROLLMENT FORMS ARE AVAILABLE THROUGH THE PAYROLL DEPARTMENT, PLEASE CALL THEM AT x6412 OR GO TO THEIR PUBLIC FOLDER IN OUTLOOK.

 pension plans: calpers & calstrs

PERS:

PERS Address Change Form (Complete and Mail to PERS)

PERS Website

PERS Beneficiary Designation Form

STRS:

STRS Address Change Form (Complete and Mail to STRS)

STRS Website

STRS Forms including Beneficiary Designation  

The Hartford:

Long Term Disability Insurance:

    - Academic Managers & Full-Time Faculty

    - Classified Managers, Supervisors & Confidential Employees

    - CSEA Unit Members

Life Insurance

Basic Life Insurance & Accidental Death and Dismemberment (All)

Hartford Beneficiary Form

Supplemental Life Insurance Brochure (Please contact HR.Benefits@sjeccd.edu to request an enrollment form)

Personal Health Application

Estate Planning Assistance

Travel Assistance Program

Addition Benefits/Resources from Hartford

To view the PowerPoint presentation on beneficiary designations, purchasing additional life insurance to and other benefits/services The Hartford provides eligible employees (from presentations held onsite April 14, 2015) please click the link below:

Supplemental Life Insurance Workshop, April 2015

 claim forms

VSP Out-of-Network Claim Form

iGOE Flexible Benefit Plan Reimbursement Request Form

 summary of benefits and coverage (sbc's)

Anthem Blue Cross

• For Active Enrollees including COBRA (group numbers 40911A, 409112A, 409113A)
• For Early Retirees <65 years old (group numbers 40911J, 40911K)

Kaiser Permanente

• Regular Active Employees including Adjunct Faculty (group #604352-0077, 604352-0078, 604352-0079)     
• Early Retirees <65 years old (group #604352-0177 & 604352-0180)     

Delta Dental

• For All Enrollees (Active & Retired) 

Summaries are not available for medical plans tied to Medicare